Wang Huaning, Wu Tao, Dong Sijia, Guan Muzhen, Liu Ao, Jiang Kun, Chi Rui, Qiu Hong, Dong Wentian, Si Tianmei
Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, China.
Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, China.
J Affect Disord. 2022 May 15;305:77-84. doi: 10.1016/j.jad.2022.02.054. Epub 2022 Feb 28.
Little is known about the characteristics of Treatment-Resistant Depression (TRD) in China. In previous studies various identification approaches have led to a wide range of results, and it is unclear how Chinese patients compare to those in other studies.
This is a retrospective cohort study using electronic health records (EHR) from two major psychiatric hospitals in China. Adult major depressive disorder (MDD) patients who initiated pharmaceutical treatment during 2010-2018 were enrolled and follow-up was 1 year. TRD was primarily identified by consensus definition of two failures of adequate (≥4 weeks) regimens. Alternative regimens of 2-weeks and 6-weeks duration, and a data-driven definition were also applied.
In the two hospitals, 12,257 (mean age: 40.8y, 63.6% female) and 8314 (mean age: 42.4y, 68.4% female) eligible patients were included. The 1-year incidence rate of TRD was estimated to be 5.2%-7.7% using the primary definition. TRD patients had mean treatment duration of 302.5 days and 285.7 days; had 3.6 and 3.7 treatment steps on average; 94.0% and 72.6% were prescribed polypharmacy regimens, which were all marginally greater than that of non-TRD patients. Alternative definitions resulted in a wide range of incidence estimates (0.5%-20.0%).
Medications were assumed to be consumed as prescribed and lack of rating scales from EHRs may limit our TRD identification.
The incidence of TRD among Chinese MDD patients was comparable to other countries under similar settings and more complex treatment characteristics were observed among TRD patients. Alternative TRD definitions revealed the need for better treatment management in practices.
在中国，关于难治性抑郁症（TRD）的特征知之甚少。在以往的研究中，各种识别方法导致了广泛的结果，尚不清楚中国患者与其他研究中的患者相比情况如何。
这是一项回顾性队列研究，使用了来自中国两家主要精神病医院的电子健康记录（EHR）。纳入了2010年至2018年期间开始药物治疗的成年重度抑郁症（MDD）患者，并进行了1年的随访。TRD主要通过充分（≥4周）治疗方案两次失败的共识定义来确定。还应用了持续时间为2周和6周的替代方案以及数据驱动的定义。
在这两家医院中，分别纳入了12257名（平均年龄：40.8岁，63.6%为女性）和8314名（平均年龄：42.4岁，68.4%为女性）符合条件的患者。使用主要定义估计TRD的1年发病率为5.2%-7.7%。TRD患者的平均治疗持续时间分别为302.5天和285.7天；平均有3.6步和3.7步治疗；94.0%和72.6%接受了联合用药方案，均略高于非TRD患者。替代定义导致发病率估计范围广泛（0.5%-20.0%）。
假设药物按规定服用，且电子健康记录中缺乏评定量表可能会限制我们对TRD的识别。
中国MDD患者中TRD的发病率与其他国家在类似情况下相当，并且在TRD患者中观察到了更复杂的治疗特征。TRD的替代定义表明在实践中需要更好的治疗管理。
